When British Columbia introduced universal free prescription contraception in April 2023, Dr. Elizabeth Nethery and her colleagues at UBC's faculty of pharmaceutical sciences saw an opportunity to measure something that had never been clearly quantified before: what actually happens to people's wallets when cost barriers vanish. Two years of pharmacy data painted a striking picture—patient out-of-pocket spending on contraception plummeted by 83%, with young adults in their 20s experiencing the sharpest relief.
This matters because contraception affordability is not a luxury question. Unaffordable contraception is directly linked to higher rates of unintended pregnancy, which carries cascading consequences for health, education, and economic opportunity. In Canada, roughly two out of five pregnancies are unintended, a burden that falls disproportionately on people with fewer financial resources. Before B.C.'s policy, nearly 40% of prescription contraception costs came straight out of patients' pockets—the highest rate in Canada and well above most other prescription drugs. For young adults, that figure climbed to about 45%, reflecting a particular vulnerability: people in their 20s often fall into a coverage gap, off a parent's insurance plan but not yet employed in jobs offering benefits.
The numbers before the policy reveal why this gap mattered so acutely. Birth control pills averaged $25 per month. IUDs ranged from $75 to more than $500 upfront. For someone relying on pills long-term, lifetime costs could reach $10,000. After April 2023, those barriers dissolved. Young adults saw their out-of-pocket share fall by roughly 33 percentage points. Across all patient groups, prescriptions with any patient cost dropped to under 10%, and the share of fully covered prescription contraceptives reached 5%. Two years into the program, the average contraceptive user saved $43 per year compared to what spending models had predicted.
What surprised many policymakers was what did not happen: system costs remained essentially stable. Researchers analyzed pharmacy data from all 10 Canadian provinces, using jurisdictions without universal coverage as comparison groups. Despite the dramatic drop in patient spending, total contraceptive costs across patients, insurers, and the public system stayed essentially unchanged. The policy did, however, shift which methods people chose. Uptake of long-acting reversible contraceptives—IUDs and implants—increased, meaning more people moved toward the most effective options available.
"Universal coverage works," said Dr. Laura Schummers, an assistant professor at UBC and senior author of the study, published in JAMA Health Forum. "Removing cost barriers increased uptake of the most effective methods, which helps reduce unintended pregnancy and inequality—adding to strong evidence that universal contraception coverage is essential in Canada."
The momentum is spreading. Manitoba introduced a similar program in October 2024 with early results matching B.C.'s experience. At the federal level, Canada passed pharmacare legislation in 2024 committing to public coverage of contraception, though implementation agreements so far involve only three provinces and one territory. For the millions of Canadians for whom cost has determined access, the shift underway suggests that policy can move faster than assumptions about what is politically possible.